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An Examination of Clinical Decision Support for Discharge Planning: Systematic Review, Simulation, and Natural Language Processing to Elucidate Referral Decision Making
No full textStatement of the Problem: As healthcare data becomes increasingly prolific and older adult patient needs become more complex, there is opportunity for evidence-based technology such as clinical decision support systems (CDSS) to improve decision making at the point of care. Although CDSS for discharge planning is available, few published tools have been translated to new settings. Existing studies have not explored discordance between recommended and actual discharge disposition. Understanding the reasons why patients do not receive optimal post-acute care referrals is critical to improving the discharge planning process for older adults and their families. Methods: Three-paper dissertation examining CDSS. Paper 1 is a systematic review of studies with prediction models for post-acute care (PAC) destination. Paper 2 is a retrospective simulation of a discharge planning CDSS on electronic health record (EHR) data from two hospitals to examine differences in patient characteristics and 30-day readmission rates based on a CDSS recommendation among patients discharged home to self-care. Paper 3 is a natural language processing (NLP) study including retrospective analysis of narrative clinical notes to identify barriers to PAC among hospitalized older adults and create an NLP system to identify sentences containing negative patient preferences. Results: Most prediction models in the literature were developed for specific surgical populations using retrospective structured EHR data. Most models demonstrated high risk of bias and few published follow-up studies. In the simulation study, surgical patients identified by the CDSS as needing PAC but discharged home to self-care experienced adjusted 51.8% higher odds of 30-day readmission compared to those not identified. In the NLP study, the top three barriers were patient has a caregiver, negative preferences, and case management clinical reasoning. Most patients experienced multiple barriers. The negative preferences NLP system achieved an F1-Score of 0.916 using a deep learning model after internal validation. Conclusions: Future prediction modeling studies should follow TRIPOD guidelines to ensure rigorous reporting. Findings from the simulation and NLP studies suggest transportability of the CDSS to large urban academic health systems, especially among surgical patients. Incorporating natural language processing variables into CDSS tools may aid the identification of barriers to PAC
From Meditation to Information: Reading After Unigenitus
No full textIn 1713, the Papal Bull Unigenitus condemned 101 propositions extracted from the Jansenist Pasquier Quesnel\u27s popular, seventeenth-century, French-language Bible commentary, the Réflexions morales. This dissertation argues that Unigenitus and the controversies that followed it transformed the ways in which readers of the controversies read and conceived of what they were doing when they did so. Confronted by all legitimate authorities in the Church and French monarchy, Jansenist polemicists appealed to the public to judge if Unigenitus\u27 condemnation of Jansenism was just. To judge, though, this public needed to be informed. To this end, Jansenist polemicists prescribed new models of reading and provided members of this public with both theological and historical arguments to justify the condemned doctrine. These arguments took a wide variety of forms, including cutting-edge genres, such as periodicals; more traditional ones, such as catechisms and almanacs; and non-textual forms, such as engravings and songs. These messages traveled through both formal and informal channels of the licit and clandestine French book trades. The contents of these texts, their forms, and the modes of production and distribution used to bring them to readers conditioned reading in significant ways, notably, by positioning readers on the side of truth against the arbitrary power of the Church and the French monarchy. The ultimate effect of this campaign was a transformation in reading practices from a reading practice that was primarily meditative, focused on a small corpus of mostly books of piety and aimed at elevating one\u27s thoughts to God through self-reflection, to one that was primarily informative, centered on a wider corpus of texts, especially newspapers and contemporary histories, and aimed at gathering knowledge for judgment and argument in the here and now. In helping to bring about this shift, the Unigenitus controversies contributed, in ways both intended and unintended, to a more general reading revolution in eighteenth-century Europe and to the making of the critical spirit of the Age of Enlightenment among readers up and down the social hierarchy
Music After the Cultural Revolution: Transnational Precarity for China\u27s One-Child Generation
No full textThis dissertation studies the intergenerational effects of the Chinese Cultural Revolution and the transnational careers of Chinese musicians born and raised during the one-child policy. Bridging scholarship in ethnomusicology and musicology with work in cultural anthropology, East Asian studies, Asian American studies, and literature studies, I examine the palpable memories and traumas from the Cultural Revolution and show that they continually frame individual and collective engagements with music in the People’s Republic of China and the Chinese diaspora. At the core of this research are extensive multi-sited ethnography conducted in the PRC, Taiwan, Canada, and the United States, and archival sources. Using these interdisciplinary methodologies, I address Chinese music-making practices in relation to personal and familial desires, and national transformations. I argue that although some Chinese musicians have achieved the highest levels of institutional success through conservatory training and international performances, they are continually motivated by anxieties of socio-economic precarity and desires for redress from parents who lost musical ambitions during the Cultural Revolution. As a result, Chinese musicians use what I term “strategic citizenship” to create transnational opportunities and seek stable futures for themselves while navigating neoliberal systems that impact their educational pathways and possibilities for new residency in countries such as Canada and the United States
Ancient Solutions of the Ricci Flow on Compact Homogeneous Spaces
No full textWe investigate the behaviour of the Ricci flow for homogeneous metrics on spheres and on general compact homogeneous spaces. In particular we complete the classification of ancient homogeneous solutions on spheres and discover a new 1-parameter family of ancient solutions. These solutions can be described in terms of shrinking the fibers of the Hopf fibration while varying the metric on the base. Precisely one solution collapses along the backwards flow to the Fubini-Study metric while the rest collapse to Ziller\u27s second Einstein metric on . We then proceed to determine a general criterion for the existence of collapsed ancient solutions on compact homogeneous spaces. In particular, we show that whenever is the total space of a homogeneous fibration where is a maximal torus in a compact complement of in , then for every Einstein metric on the base there exists a family of ancient solutions on which collapse to the given Einstein metric under the backwards flow. This construction generalizes all previously known examples of collapsed homogeneous ancient solutions in the literature, and also leads to many new families of examples
Collation Model for Ms. Codex 1256: [Legal records]
Get PDFA series of legal records of the Bagnano family, dated from 1493 to 1604. There is a table of contents on the inside of the upper and lower covers, listing the years, page numbers, and brief descriptions of the records in Italian. A collection of legal records, mostly consisting of wills, contracts, deeds, and inheritances. Some of the records include disagreements over inheritance, and others deal with claims of various monasteries in Florence. The family is sometimes referred to as Albagnano. Many of the records are notarized and contain notarial signets. Contains some marginal notes in a near-contemporary hand.https://repository.upenn.edu/sims_models/1107/thumbnail.jp
Collation Model for Ms. Codex 75: Pupilla oculi
Get PDFHandbook of canon law and pastoral theology for parish priests (f. 1r-177v). It appears to be a reworking of an earlier manual (circa 1320) by William of Pagula. Part and chapter numbers are written in the upper outer corners, and subsections of chapters are marked with marginal letters in alphabetical order, a through z, then aa-az, ba-bz if necessary (for example, f. 68v). Followed by an alphabetical register (tabula) for the work (f. 178r-193v), which references the chapter section letters. Written in England or Wales in the first quarter of the 15th century..https://repository.upenn.edu/sims_models/1102/thumbnail.jp
El Lugar De Lo Global. Concepciones Del Tiempo Y El Espacio En Novelas Latinoamericanas Durante La Globalización Digital
No full textEl objetivo de esta disertación es estudiar la representación en la narrativa latinoamericana contemporánea de los cambios traídos por el proceso globalizador, a partir de la lectura de cuatro novelas: 2666 -2004-, de Roberto Bolaño (Chile, 1953-2003); El juego de los mundos -2000 y 2019-, de César Aira (Argentina, 1949); Nefando -2016-, de Mónica Ojeda (Ecuador, 1988); y Kentukis -2018-, de Samanta Schweblin (Argentina, 1978). Dado que se busca entender el proceso globalizador de manera que no lo considere simple problema económico, sino también como problema cultural e identitario, se establecen diferencias entre los conceptos de “globalización” y “globalidad”, y se lleva el concepto de “identidades híbridas” a la negociación entre localidad, nacionalidad y globalidad. Para estudiar cómo las novelas escogidas muestran los cambios en las nociones de tiempo y espacio, a partir de la propuesta de Josefina Ludmer de leer la simultaneidad global como “tiempo cero” se usa un enfoque relacional entre personajes partiendo de la noción de “sincronía” y se crea el concepto de “espacio 0” para describir tecnologías donde pueden manipularse objetos situados en un espacio lejano. Para definir el período de estudio, el modelo de la globalización en cinco fases de Roland Robertson se amplía a una sexta fase, a la que se llama globalización digital , con la intención de diferenciar mejor la fase actual del proceso globalizador en la que internet y las tecnologías digitales cumplen un papel vital en dicho proceso
Nanofabrication Engineering For Molecule Sensing Beyond Single Solid-State Nanopore Measurements
No full textNanopore-based DNA sequencing provides several advantages over alternative conventional methods, e.g., single-molecule detection, long reading lengths, chemical label-free samples, reduced contamination during the sample preparation process. While protein nanopores sequencing has advanced into the stage of commercialization over the past few decades, solid-state nanopores still hold promises regarding high-throughput reading, high signal-to-noise (SNR) ratio detection, and long-term stability and operating lifetime under extreme environments.In this dissertation, we first qualitatively investigate the stability of silicon nitride (SiN) nanopores by storing devices in various electrolyte solutions and measuring open- pore conductance over a period of months. A series of corresponding pore diameter etch rates is reported. And we further utilize a conformal 1-nm-thick hafnium oxide (HfO2) layer to prolong the nanopore devices\u27 lifetime effectively. Next, we demonstrate biomolecules translocations measurements with traditional single solid-state nanopore devices, using silicon nitride and tungsten disulfide (WS2) nanopores, respectively. To further explore possibilities beyond single nanopore sensors, we showcase an in-plane parallel two-pore device. We can analyze and categorize event detections from each nanopore using a conventional two-terminal measurements setup. This outcome can be achieved due to the high sensitivity in detection current signals regarding the nanopore geometry design, i.e., pore diameters and thicknesses. Additionally, we propose and demonstrate an advanced two-layer device. We combine the well-developed fabrication technique for SiN, and the optimized spatial resolution of a one-atomic-layer thin molybdenum disulfide (MoS2) nanopore. We introduce a guiding and reusable (GURU) platform, where we position a 2D monolayer above the silicon nitride (GURU) layer. Aiding with simulation results from COMSOL, we provide a detailed look into this coupled two- layer nanopore system
Do Stimulus Checks Work?
Get PDFThe COVID-19 pandemic has greatly affected billions of lives around the world, and the CARES Act, the largest relief package in United States history was created to alleviate the effects of the pandemic. This policy introduced stimulus checks, direct payments to individuals and families that aimed to incentivize the consumption of goods and thus revive the economy. In this thesis I ask the question: do stimulus checks work? I try to answer this question using data from the Consumer Expenditure Survey, published by the Bureau of Labor Statistics, and utilizing household expenditures as a proxy for consumption in the economy. I format the data into aggregate monthly expenditures and calculate the monthly percentage change for 2019 and 2020 and find that returns in April-August 2020 seem abnormally larger than those seen in the same months in 2020. Using Python, I conduct three multiple linear regressions with varying sets of predictors to test whether the increase in expenditures for those months is indeed statistically significant. Among the findings uncovered by this analysis, I find that expenditures in April-July 2020 were, on average, 41.55 USD higher than other months in 2020 on average
The Minor Declamations And Roman Rhetorical Education
Get PDFIn this dissertation, I demonstrate how the Minor Declamations, a Latin rhetorical text of unknown authorship from the early Roman empire, can be used as a window into the ways that Romans of the imperial period taught and learned the rhetorical skills that would dominate their future as speakers, writers, and thinkers. Originating from the classes of an unknown Teacher, these declamatory controversiae with didactic comments provide unprecedented insights into Roman rhetorical instruction. I first use paratexts transmitted together with the Minor Declamations to reconstruct their earliest physical form as a cache of class notes which was only gradually assembled into the collection we have today. Then, I demonstrate that units of individual controversiae reflect curricular progression. Contrary to current belief, stylistic features of certain parts of the text suggest that some of these units could have been written down by students during class time, and not prepared in advance by the Teacher. In other words, at least some parts of the text are a collective product of the Teacher who delivered the lectures and the students who edited his lessons as they wrote them down. Finally, I show that this Teacher had adopted a pragmatic teaching philosophy in designing his curriculum: he only taught the core parts of a declamatory speech (argumentation) and bypassed the marginal ones such as proems and epilogues. From his programmatic statements scattered across the collection I conclude that this approach was crafted in response to the current debates on style and “decline of oratory.” The Teacher defended his choices from students’ criticism, arguing that an excess of epideictic elements results in declamation which is pleasurable to the ears, but not supported by a strong substructure of logical arguments. He knew that moving the audience was important to the students, but he insisted that making their speeches appealing is something they could do on their own, while argumentation needed to be learned through sustained practice. His program is therefore not striving to change the prevailing taste, but rather to ensure modern oratory has substance